Stigma experienced by Chinese patients with stroke during inpatient rehabilitation and its correlated factors: a cross-sectional study

Negative disease-related stigma 3-months after hemorrhagic stroke is related to functional outcome and female sex

OBJECTIVES

The objective of this study was to determine factors associated with negative disease-related stigma after hemorrhagic stroke.

MATERIALS AND METHODS

Patients with non-traumatic hemorrhage (ICH or SAH) admitted between January 2015 and February 2021 were assessed by telephone 3-months after discharge using the Quality of Life in Neurological Disorders (Neuro-QoL) Negative Disease-Related Stigma Short Form inventory. We evaluated the relationship between disease-related stigma (T-score >50) and pre-stroke demographics, admission data, and poor functional outcome (3-month mRS score 3-5 and Barthel Index <100).

RESULTS

We included 89 patients (56 ICH and 33 SAH). The median age was 63 (IQR 50-69), 43 % were female, and 67 % graduated college. Admission median GCS score was 15 (IQR 13-15) and APACHE II score was 12 (IQR 9-17). 31 % had disease-related stigma. On univariate analysis, disease-related stigma was associated with female sex, non-completion of college, GCS score, APACHE II score, and 3-month mRS score (all p < 0.05). On multivariate analysis, disease-related stigma was associated with female sex (OR = 3.72, 95 % CI = 1.23-11.25, p = 0.02) and 3-month Barthel Index <100 (OR = 3.46, 95 % CI = 1.13-10.64, p = 0.03) on one model, and female sex (OR = 3.75, 95 % CI = 1.21-11.58, p = 0.02) and 3-month mRS score 3-5 (OR = 4.23, 95 % CI = 1.21-14.75, p = 0.02) on a second model.

CONCLUSION

Functional outcome and female sex are associated with disease-related stigma 3-months after hemorrhagic stroke. Because stigma may negatively affect recovery, there is a need to understand the relationship between these factors to mitigate stroke-related stigma.

Comparison of clinical outcomes between family caregivers and professional caregivers in in-hospital patients with acute ischaemic stroke: A prospective cohort study

AIM

This study explored the impact of different care modes on the outcome of hospitalized patients with acute ischaemic stroke (AIS) during hospitalization and 3 months after discharge.

METHODS

This was a prospective cohort study comparing the outcomes at hospitalization, at discharge, and at 3 months post discharge among AIS patients with different caregiving arrangements from 9, December 2022 to 20, August 2023. The general information questionnaire, Modified Barthel Index, Shortened General Comfort Questionnaire, Perceived Social Support scale, Herth Hope Index, modified Rankin scale and EQ-5D-5L were utilized for the investigation.

RESULTS

The psychological evaluation scores during hospitalization, including comfort, perceived social support, and hope, did not significantly differ between the two groups of AIS patients (p > .05). Moreover, there were no significant impacts observed in terms of length of stay (LOS) at the hospital or hospitalization expense (p > .05). The proportion of patients with intact functionality was greater in the family caregiver group 3 months after discharge (16.5%). However, when stratified based on prognosis, the difference in outcomes between the two groups of patients did not reach statistical significance (p > .05). The analysis of ADL, quality of life and stroke recurrence in 276 surviving ischaemic stroke patients 3 months post discharge indicated no differences between the two groups across all three aspects (p > .05).

CONCLUSION

Older and divorced or widowed AIS patients tend to prefer professional caregivers. The psychological state during hospitalization, length of hospital stay and hospitalization expenses are not influenced by the caregiving model. Three months post discharge, a greater proportion of patients in the family caregiving group had intact mRS functionality, but this choice did not impact patient prognosis, stroke recurrence, quality of life or independence in ADL.

Stigma following acquired brain injury and spinal cord injury: relationship to psychological distress and community integration in the first-year post-discharge

PURPOSE

This study aimed to compare stigma levels after acquired brain injury (ABI) and spinal cord injury (SCI) during the first 12-months post-discharge and investigate relationships between stigma, psychological distress and community integration.

METHODS

110 adults with ABI (55%) or SCI (45%) were recruited from brain and spinal cord injury inpatient rehabilitation units of a tertiary healthcare facility. They were administered Neuro-QOL Stigma subscale and Depression Anxiety and Stress Scales (DASS-21) at discharge, 3-months and 12-months post-discharge, and Community Integration Measure at 12-months post-discharge.

RESULTS

Stigma levels did not significantly differ between individuals with ABI and SCI. However, stigma significantly decreased between discharge and 12-months post-discharge for the total sample. Stigma was positively associated with psychological distress at discharge and 3-months post-discharge, but not at 12-months post-discharge. Lower functional status and power wheelchair use were associated with higher stigma at 12-months post-discharge. Stigma at 3-months post-discharge predicted community integration at 12-months post-discharge, controlling for psychological distress and functional status.

CONCLUSION

Experience of stigma in the first few months post-discharge may negatively impact individuals' community reintegration. The early post-discharge period may be a pivotal time for supporting individuals to explore disability and injury-related appraisals and enhance connection to their community.

The cognitive appraisal path of stroke knowledge, coping traits, family functioning and stigma among stroke patients: A moderated parallel mediation model

AIMS

To establish a cognitive appraisal path model that examines the impact of stroke knowledge on stigma with the parallel mediating effects of negative and positive coping traits, as well as the moderating effects of family functioning.

BACKGROUND

Stroke-related stigma, a 'mixture' of negative emotions involving internal criticism and external judgement, has been shown to impair patients' health outcomes. However, the specific factors underlying cognitive appraisals and their pathways remain unknown.

DESIGN

A cross-sectional design.

METHODS

The cross-sectional sample was from two stroke centres in China. Questionnaires were administered to collect sociodemographic data, stroke knowledge, coping traits, family functioning and stigma. Hierarchical regression models and the moderated parallel mediation model were constructed to analyse influencing pathways. The study adhered to the strengthening the reporting of observational studies in epidemiology guideline.

RESULTS

All 144 samples reported stigma symptoms with a moderate-to-high standardising score. The best hierarchical regression model explains 55.5% of the variance in stigma. The parallel mediation model indicated that negative and positive coping traits co-mediating the association of stroke knowledge and stigma. After adding the family functioning as a moderator, the moderated parallel mediation model was confirmed with adequate fit indices.

CONCLUSION

Among the cognitive appraisal factors affecting stroke-related stigma, stroke knowledge reduces stigma by modifying coping traits, while poor family functioning may serve as an opposing moderator. Notably, when family support is insufficient, enhanced stroke knowledge might paradoxically exacerbate the stigma.

RELEVANCE TO CLINICAL PRACTICE

This study contributes knowledge on transforming health education and emphasises the pivotal roles of clinical nursing practitioners. In similar global contexts, the study highlights integrating health education, psychological counselling and family support to advance systematic nursing practices.

PATIENT OR PUBLIC CONTRIBUTION

None.

Development of the Japanese version of the stroke stigma scale: a validity and reliability assessment

BACKGROUND

The stigma perceived by many post-stroke persons hinders their social lives. A scale to measure stigma is needed to identify social problems related to stigma, and to evaluate effectiveness of interventions.

OBJECTIVES

This study aimed to develop a Japanese version of the Stroke Stigma Scale (SSS-J), and confirm its utility by examining reliability and validity.

METHODS

Eighty community-dwelling post-stroke individuals were enrolled at six sites. After translating the scale into Japanese using back translation methods, psychometric properties of the rating scale, internal scale validity, and reliability were examined to fit the Rasch model. Criterion-related validity, construct validity, and test-retest reliability were examined using total scores transformed to logit. For test-retest reliability, 30 participants completed the SSS-J twice, one week apart.

RESULTS

Rasch analysis showed that the SSS-J had the best fit with 15 items on a 3-category rating scale. Item difficulty logits were -2.01 to 2.21, person ability logits were -4.69 to 0.62 (mean, -1.41), person reliability coefficient was 0.71 (separation index, 1.58), and item reliability coefficient was 0.96 (separation index, 5.04). For criterion validity, Spearman's rank correlation coefficient with the Center for Epidemiologic Studies Depression Scale was 0.51 (p < 0.001). For construct validity, Spearman's rank correlation coefficients with each subscale of the Stroke Impact Scale ranged from -0.36 to -0.16 (p = 0.002-0.126). For test-retest reliability, the intra-class correlation coefficient was 0.64 (p < 0.001).

CONCLUSIONS

The SSS-J adapted to the Rasch model was reliable and valid. This scale can be used to quantitatively measure stigma among community-dwelling post-stroke persons in Japan.

Trends and disparities in non-communicable diseases in the Western Pacific region

The WHO Western Pacific region bears disproportionate deaths from non-communicable diseases (NCDs), with increased overall NCD proportional mortality over the past two decades. The disease burden of mental health increased, resulting from rapid ageing, enhanced stress, and the COVID-19 pandemic, but it was largely neglected. The highly diverse cultures, religions, political systems, socioeconomic contexts, lifestyles, and environmental factors probably have led to massive disparities across countries in NCD mortality, risk factors, and NCD management. Geographically, East Asia had the lowest NCD mortality whilst Pacific islands had the highest. Economic booms, ageing, nutrition transition, social stress, prevalent tobacco use, and fast-increasing obesity and hyperglycaemia are important drivers of NCDs. Men tended to have more adverse behavioural and metabolic risk factors. Rural residents are catching up with their urban counterparts in metabolic risk factors and conditions. Sustainable strategies tailored to NCD patterns are needed to fight the NCD epidemic and related disparities.

The mediation effect of social support between stigma and social alienation in patients with stroke

Background

Social alienation is prevalent and causes adverse outcomes in stroke. Previous studies have linked stigma with social alienation. However, little is known about the mechanisms behind this relationship. This study explored the mediation effects of social support between stigma and social alienation.

Methods

A cross-sectional design was used to study 248 patients with stroke admitted to a tertiary rehabilitation hospital in Beijing, China, from December 2022 to July 2023. Patients were assessed using a general information questionnaire, the Stroke Stigma Scale, the Social Support Rating Scale, and the Generalized Social Alienation Scale. The PROCESS macro in SPSS was used to examine the mediation model.

Results

The results showed that stigma has a negative effect on social support (β = -0.503, p<0.001); stigma has a positive effect on social alienation (β = 0.768, p<0.001). Social support mediated the relationship between stigma and social alienation, with a mediation effect of 0.131 (95%CI: 0.060, 0.214), and indirect effects accounted for 17.06% of the total effect.

Conclusion

Social support mediated the relationship between stigma and social alienation. These findings suggest that intervention targeting the enhancement of social support may prevent or reduce social alienation among patients with stroke.

Anticipated stigma and associated factors among chronic illness patients in Amhara Region Referral Hospitals, Ethiopia: A multicenter cross-sectional study

Background

Anticipated stigma related to chronic illness patients undermines diagnosis, treatment, and successful health outcomes. The study aimed to assess the magnitude and factors associated with anticipated stigma among patients with chronic illness attending follow-up clinics in Amhara Region Referral Hospitals, Ethiopia.

Methods

A cross-sectional institution-based study was conducted in Amhara Region Referral Hospitals from 01 March to 15 April 2021. A simple random sampling technique was used to select the three Referral Hospitals in the region and study subjects. Data were collected using a pre-tested interview-based questionnaire. Data were entered and cleaned with Epi-Info version 6 and exported for analysis STATA version 14. Multiple linear regression was used to show the association between anticipated stigma and potential factors. Associations were measured using ß coefficients and were considered statistically significant if the p-value > 0.05.

Results

A total of 779 patients were included for analysis with a response rate of 97%. Their mean (Standard deviation) of anticipated stigma was estimated at 1.86 and 0.5, respectively. After running an assumption test for multiple linear regression; educational status, cigarette smoking, psychological distress, medication adherence, alcohol consumption, and social part of the quality of life were statically significantly associated with anticipated stigma.

Conclusion and recommendation

The result showed a high level of anticipated stigma reported among the participants. Emphasizing improving their social part of the quality of life, avoiding risky behaviors like alcohol consumption and cigarette smoking, access to health education for chronically ill patients, integrating mental health in all types of chronic disease, and developing strategies and protocols which will help to improve patient medication adherence to their prescribed medication will be crucial. This can provide a foundation for government andnon-governmental organizations, and researchers implementing evidence-based interventions and strategies on chronic care to address factors related to anticipated stigma.

Development of a self-help cognitive behavioral therapy programme for reducing the stigma of stroke survivors: a modified delphi study

BACKGROUND

Stigma is a common psychological consequence for stroke survivors that aggravates their physical and psychological burden and hinders their rehabilitation. Currently, there are few interventions targeted at the stigma of stroke survivors.

OBJECTIVES

This study reports on the development of a self-help cognitive behavioral therapy (CBT) programme driven by a logical model of stigma in stroke survivors, CBT and the advice of multidomain experts.

METHODS

A logical model of stigma in stroke survivors was derived from a systematic search of the literature and semistructured interviews with 21 patients to identify factors influencing stigma. The item content of the programme was generated based on this logical model in combination with CBT. A modified Delphi process with an expert panel of multidomain experts was used to evaluate and refine the content of the programme. SPSS 20.0 was used for data analysis.

RESULTS

Seventeen experts accepted the invitation to participate, and all completed two rounds of the Delphi survey. Six sections and 26 items were identified. Consensus was reached among experts that the self-help CBT programme included the following six sections: health education, understanding stigma, cognition change, skills training and self-care, self-acceptance and relapse prevention.

CONCLUSIONS

The self-help CBT programme includes health education and psychological education. This study extends the limited body of research on stroke-related stigma interventions, and the next step is to evaluate its efficacy in trials.

Correlates of stigma for poststroke patients: A meta-analysis

AIMS

A meta-analysis was carried out to review and identify correlates of stigma in poststroke patients.

BACKGROUND

Patients suffer from impaired physical functions and sequelae of stroke. Stroke-related stigma hinders the recovery process and produces poorer clinical outcomes of stroke, leading to compromised quality of life.

DESIGN

A systematic review and meta-analysis was reported by following PRISMA 2020 guidelines.

REVIEW METHODS

Nine databases were searched from their inception to May 2021 to identify studies focused on the relationships among demographics, disease-related factors, psychosocial factors and poststroke stigma. Included studies were assessed by using the Agency for Healthcare Research and Quality (AHRQ) scale. The statistical software R studios were used to perform statistical analysis.

RESULTS

Nineteen studies were included in the meta-analysis. Four demographic factors (age, caregiver, residence, monthly income), seven stroke-related characteristics (type of stroke, mRS, ADLs, stroke duration, recurrence, sequelae, chronic disease comorbidity) and three psychosocial factors (depression, social support, quality of life) showed significant associations with stroke-related stigma.

CONCLUSIONS

The results of our study can serve as a foundation for designing interventions to reduce stigma and improve the overall quality of life of poststroke patients and may produce positive clinical outcomes. Healthcare professionals should be aware of stroke patients who are characterised by correlates of stigma. Relevance to clinical practice Poststroke patients showed a moderate-to-high level of stigma, and this issue warrants more attention. This review provides a preliminary foundation for healthcare professionals to develop interventions to address stroke-related stigma by focusing on demographic, disease-related and psychosocial factors. Additionally, stigma identification should be a part of clinical nursing evaluation. The involvement of clinical and community nursing is very important to screen stroke-related stigma and pay attention to this population.

Stigma, depression, and post-traumatic growth among Chinese stroke survivors: A longitudinal study examining patterns and correlations

Background: With the development of positive psychology, several studies show that positive and negative emotions are not always opposing. Understanding how positive and negative emotions correlate and the factors contributing to resilience in stroke survivors requires further research.Objectives: To identify the patterns and correlations of stigma, depression, and posttraumatic growth (PTG) among stroke survivors.Methods: Stroke-related stigma, depression, PTG, and neurological status were evaluated at 1-month and 3 months post-stroke using the Stroke Stigma Scale (SSS), Patient Health Questionnaire-9 (PHQ-9), Chinese version of the Posttraumatic Growth Inventory (C-PTGI), modified Rankin Scale (mRS), and Social Support Rating Scale (SSRS). The paired t-test, nonparametric test, and Spearman's correlation test were used to analyze differences and relationships between results at the two time points.Results: At 3 months compared to 1-month post-stroke, we found significant reductions in mRS and stigma scores, and an increase in PTGI scores, while the PHQ-9 scores reduced non-significantly. SSS, PHQ-9, and mRS scores were positively correlated with each other at time1 (all P < .01), and all showed no significant relationships with PTGI scores (all P > .05). Social support scores were negatively correlated with stigma (P < .01), PHQ-9 (P < .01), and PTGI scores (P > .05) at 3 months.Conclusions: Stroke-related stigma is strongly associated with depression while neither of them has significant relationships with PTG during the early stage of survivors' rehabilitation in our study. Neurological impairment is a risk factor for negative emotions and increasing individualized support may reduce stigma, depression, and promote PTG in the long term.